| Thomas L. Prendergast, Dds, Pc | |
|
1394 S Route 12 Fox Lake IL 60020-1949 | |
| (847) 587-5053 | |
| Not Available |
| Full Name | Thomas L. Prendergast, Dds, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1394 S Route 12, Fox Lake, Illinois |
| Authorized Official Name and Position | Thomas L. Prendergast (PRESIDENT) |
| Authorized Official Contact | 8475875053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas L. Prendergast, Dds, Pc 1394 S Route 12 Fox Lake IL 60020-1949 Ph: () - | Thomas L. Prendergast, Dds, Pc 1394 S Route 12 Fox Lake IL 60020-1949 Ph: (847) 587-5053 |
| NPI Number | 1639438765 |
|---|---|
| Provider Enumeration Date | 05/09/2012 |
| Last Update Date | 05/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639438765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019-022387 (Illinois) | Primary |